After a emotional stimulation, BPD reacts faster and in a more intensive way. That leads to ruminative thoughts as a strategy to regulate emotionality. Rumination intensify the negative emotionality which increase rumination, resulting in a vicious cycle. The dysregulated behavior tends to reduce the intensive emotions reinforcing the problematic behavior and leading to another emotional cascade because of negative emotions of guilt and shame.

From the neuro scientific literature, some evidence supported the ECM.The I cubetheoryofDenson and Pedersenexplains the relationshipbetween Anger Rum and Aggressive Beh in 3 steps.The I cube theory provides neuroscientific evidence that supported the emotional cascade in which the behavior dyscontrol is lead by rumination which consumes neuro-cognitive resources, necessary to manage behaviour.

On the basis of the previous scientific evidence, we have conducted a research involving 3 clinical and research centres

Weseparatelyconductedcorrelational and regressionanalysis on clinical sample and HV to investigate a potentiallydifferentfunctioningbetweengroups.

Aggressionispredictedby ED in bothsamples

When AR isinsert in the modelwith ED, AR ispredictedby ED, but ED looseitssignificance in predicting AQ.ThatmeansthatAR fullymediates the relationshipbetween ED and AB

2- This could be due to the presence of other Cluster B diagnosis among the OPD3-AR is the cognitvemechanismwhichleadsto aggressive behaviour.Evenif ED ispresentitdoesnotmeanthatbehaviouraldyscontrolwillbeshown

3.
Emotional Cascade Model (ECM) in BPD The Emotional Cascade Model attempts to provide a direct link between emotional dysregulation and behavioral dysregulation in BPD through a process called an “emotional cascade.” BPD patients tend to react faster to emotional stimuli, because of their high sensitivity, which leads to automatic ruminative thoughts. Many people ruminate because they believe (incorrectly) that doing so will increase their understanding of the situation and aid in problem solving (Papageorgiou & Wells 2001, Simpson & Papageorgiou 2003) (positive feedback loop) Rumination has generally been found to magnify negative affect as well as increase its duration (Nolen- Hoeksema 1998; Watkins 2008) (vicious, repetitive cycle) Behavioural dysregulation (self-harm, substance abuse or aggression) would serve as a method of “distraction” that breaks-up the emotional cascade process, due to such an intense ruminative process (relief and reinforce) Following some dysregulated behaviours, BPD may experience another emotional cascade based on negative emotions (e.g. guilt, shame) resulting from the original dysregulated behaviour (increased emotion sensitivity) Selby, Anestis et al. 2008, 2009

5.
Research evidence on healthy students with BPD traits BPD features are significantly related to both depressive and anger rumination and this relationship is not attributed to depression, anxiety and stress. The Association with BPD features was stronger for anger rumination than for depressive rumination (Bear et al 2011) BPD traits demonstrated greater reactivity and intensity of negative affect following the rumination induction than control subjects without BPD traits (Selby et al 2009) Anger rumination predicted verbal and physical aggression tendency, even after controlling for depression and anxiety symptoms (Anestis et al 2008) General Rumination mediated the relationship between psychological distress (anxiety and depression symptoms ) and dysregulated behaviour (Eating behaviour, Urgency, Substances abuse) (Selby et al. 2008)

6.
3 Neuroscientific evidence: The I Theory I3 theory suggests that anger-inducing provocation leads to angry rumination (with self- regulation property) Self regulation is costly in terms of neuro-cognitive resource because it requires: (a) managing the intensity of the anger experience, b) suppressing angry thoughts, and (c) inhibiting aggressive behaviour. Sufficient glucose must be available to the brain to engage in self-controlled behaviour (Baumeister, 1998; Hagger et al., 2010) (Gailliot 2008, 2007). The self-regulation effort through rumination consumes neuro-cognitive resourse and reduces self-control, increasing the probability that individuals will be less able to control their behaviour. Denson et al. 2008, 2011; Pedersen et al. 2011

7.
Research Settings and Aims Settings: 1. Studi Cognitivi, Cognitive Psychotherapy and Research Centre 2. Mental Health Community Centre of Bologna 3. Psychiatric Institute, Bologna University Aims:1. Assess anger rumination in clinical population (BPD and other PDs) and in healthy volunteers2. Verify that Anger Rumination mediates the relationship between Emotional Dysregulation and Aggressive Behaviour

8.
Methods: Patients and HV enrolled in the study were asked to fill in a consent form and proceed to a psychometric evaluation: Structured Clinical Diagnostic Interview for DSM-IV – Axis II (SCID-II) Borderline Personality Disorder Check List (BPDCL) is a self-report questionnaire for screening people with BPD. Anger Rumination Scale (ARS) to assess the Anger Rumination which is: (1) the tendency to ruminate on anger (2) focusing attention on angry moods (3) recalling past anger episodes (4) thinking about the causes and the consequence of anger episodes Aggression Questionnaire (AQ) to assess the tendency to Aggression which is expressed by (1) feelings of rage (2) hostility (3) verbal aggression (4) physical aggression Difficulties in Emotion Regulation Scale (DERS) to assess the Emotion Regulation which is (1) awareness, understanding and acceptance of emotions (2) ability to engage in goal-directed behaviour when experiencing negative emotions; (3) flexible use of appropriate strategies to modulate the intensity and duration of emotions (4) willingness to experience negative emotions

11.
Results: Correlational AnalysisBecause of small size of clinical sub-samples we merged BPD with OPDFinal clinical sample (CS) is composed of 49 patients with PDs Analysis showed significant correlations between all measures in the clinicalsample (Ranging from .32 to .55) Analysis showed significant correlations between all measures in healthyvolunteers (Ranging from .47 to .63)

14.
Conclusion Clinical sample showed a greater impairment in emotion regulation, in anger rumination and in aggressive behaviour than the control group. Slight significant differences were noted in Anger Rumination between BPD and OPD In both samples (CS and HV) Emotion Dysregulation predicted the Aggressive Behaviour, but this relationship is fully mediated by anger rumination

15.
Limitations and Future Research Because of small clinical samples we merged BPD and OPD. Future research should be conducted on larger sample of BPD patients Other forms of rumination should be explored in BPD in relation to behaviour and anxiety and depressive symptoms Forms of Dyscontrolled Behaviour (Aggressive acts, self-harm, binge eating) should be considered in future research